Five hundred lives a year will be saved through the creation of specialist stroke and trauma centres in London, according to a consultation launched this week. Expert clinical care and the latest technology would be concentrated in a few super - centres which would treat the most serious and life-threatening cases. And they would be linked to a network of A&E and stroke units across the capital dealing with less serious cases, rehabilitation and continued treatment .

The consultation, which is on part of Lord Darzi's ten year vision for the capital 'Healthcare for London', will look at the location and coverage of potential sites for eight specialist stroke and four major trauma centres.

Stroke is the second biggest killer in London and the most common cause of disability - around 11,500 Londoners suffer a stroke each year, about one person every hour.

The consultation calls for an extra £23m a year to be invested in delivering improved stroke care. The new stroke services would start to be delivered from early 2010.

Dr Chris Streather, Healthcare for London clinical stroke lead, said: 'Londoners deserve better access to life-saving treatment if they suffer a stroke. Clinical excellence in essential, but time is of the essence too. Many patients are treated in hospitals close to home, but the quality of clinical care they receive can be poor.'

Delivering this high quality care requires specialist multidisciplinary teams and high quality equipment available 24 hours a day, 7 days a week.

However, in 2006, out of 30 hospitals in London providing stroke services, only three treated over 90 per cent of stroke patients in a dedicated unit.

The best stroke care means rapid access to a CT scan to determine the cause of stroke, immediate treatment with clot-busting drugs, if appropriate, and physiotherapy within a few days of the stroke.

Thrombolysis - the use of clot-busting drugs - needs to occur within three hours of the onset of a stroke to be effective, and a CT scan is required before thrombolysis can occur. In 2006, no London hospital provided 90 per cent of patients with a scan within 24 hours.

Major trauma centres would deal only with the most serious cases, such as badly injured car crash victims and patients with life-threatening knife and gunshot wounds.

Currently each hospital only treats around one major trauma victim per week, 1,600 cases a year across the capital.

London currently only has one major trauma unit at the Royal London Hospital and this would be boosted to four. Up to £12m would be invested in the centres, along with improvements to all A&Es in London.

Matt Thompson, vascular surgery professor at St George's Healthcare NHS Trust said. 'The best evidence shows that dedicated major trauma centres with expert teams of professionals are able to save more lives.

'People will have a much better chance of surviving and recovering from a major trauma injury when they have direct access to specialist teams and state-of-the-art equipment to ensure immediate treatment is available, 24 hours a day, seven days a week.'

David Sissling, Programme Director, Healthcare for London said; 'There must be radical changes in how stroke and major trauma services for adults are delivered in London. Doing nothing is not an option.

'All stroke patients and trauma patients in London will benefit from improved trauma centres and hyper-acute centres. Our proposals will ensure investment, new services and world class quality for all Londoners.'

Under the Healthcare for London proposals, all Londoners will be no more than 30 minutes from a specialist stroke unit and no more than 45 minutes from a major trauma centre.

The consultation will last 14 weeks and its findings will be considered by a joint committee of primary care trusts in the summer.

-- The Stroke and Trauma consultation document is available at healthcareforlondon.nhs

-- Healthcare for London works on behalf of 31 primary care trusts in London. The programme aims to make health services in the capital better, safer and more accessible. This includes developing specialist stroke and trauma centres, better access to GPs, out of hours and more outpatient care in the community.

-- The preferred option for establishing trauma networks in London is :

Major trauma centres at:

- The Royal London Hospital;
- King's College Hospital;
- St George's Hospital;
- St Mary's Hospital

-- We are recommending developing new hyper-acute stroke units at the following hospitals:

- Charing Cross Hospital
- King's College Hospital
- Northwick Park Hospital
- Queen's Hospital
- St George's Hospital
- The Princess Royal University Hospital
- The Royal London Hospital
- University College Hospital

-- We are recommending developing local stroke units and mini-stroke centres (Transient Ischaemic Attack - TIA centres) at the following hospitals:

- Barnet Hospital
- Charing Cross Hospital
- Chelsea and Westminster Hospital
- King's College Hospital
- Kingston Hospital
- Mayday Hospital
- National Hospital for Neurology & Neurosurgery (part of University College Hospital)
- North Middlesex Hospital
- Northwick Park Hospital
- Queen Elizabeth Hospital
- Queen's Hospital
- St George's Hospital
- St Helier Hospital
- St Mary's Hospital
- St Thomas' Hospital
- The Hillingdon Hospital
- The Princess Royal University Hospital
- The Royal Free Hospital
- The Royal London Hospital
- University Hospital Lewisham
- West Middlesex Hospital

Local NHS organisations in north east London are leading a general review of acute services which will be guided by the Healthcare for London vision. Whilst there is clarity that (under the preferred option) hyper-acute stroke units, stroke units and TIA services will be provided at The Royal London and Queen's Hospital (Romford), the proposed locations of other stroke and TIA services at north east London hospitals will not be clear until the review is complete. Stroke services at Whipps Cross University Hospital, Homerton University Hospital, Newham General Hospital and King George Hospital will continue to be provided whilst the review is undertaken. All these hospitals are potential providers of stroke unit and TIA services in the future. After the review's completion in April 2009, local NHS organisations in north east London will make specific proposals for local stroke services of the highest quality. These will be submitted to the Joint Committee of PCTs for consideration and, if appropriate, approval in July 2009.

healthcareforlondon.nhs

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